Answer: A. Problem Focused Rationale: 1 element in HPI (Modifying Factor, No elements in ROS, and No elements in PFSH CC: Follow up of hospitalization for pneumonia. HPI:Modifying Factor – He was placed back on Singulair® and has been improving with his breathing since then. ROS: None PFSH: None -not required for an interval history
Answer: C. Detailed Rationale: 4 elements in HPI, 2 elements in ROS, and 1 element in PFSH CC: Asthma exacerbation HPI: Duration—Two to three days Associated signs and symptoms-cough Quality—Productive cough Severity—Getting worse ROS: Constitutional—Denies fever or chills Respiratory—Difficulty breathing PFSH:Past History—Currently uses inhalers (current medication)
Answer: B. Expanded problem focused Rationale: 3 elements in HPI, 1 element in ROS, 3 elements in PFSH CC: Skin lesions HPI:Location—Forehead and lateral to right eye Duration—About a year Associated Signs & Symptoms—another skin lesion lateral to right eye ROS:Integumentary—No other skin complaints Stated, “Otherwise well,” but this is not an indication that all other systems were reviewed. PFSH: Past, Family, and Social all reviewed as it relates to skin.
Answer: D. Comprehensive Rationale: 4 elements in HPI, Complete ROS, Complete PFSH CC: Fever HPI:Duration—Less than one day Severity—High fever Associated signs and symptoms—Decreased appetite Modifying factor—Tylenol has been given which reduced the fever ROS:GI—No vomiting or diarrhea Resp—Parents unaware of any cough Rest of review of systems reviewed and negative: Complete ROS PFSH:Personal history—Current meds Social history—Not exposed to second hand smoke Family History—Mother is an asthmatic.
Answer: B. Expanded Problem focused Rationale: 2 elements in HPI, 3 elements in ROS, 2 elements in PFSH CC: ATV accident HPI:Context—ATV accident Location—Lip and chin lacerations ROS:GI—Negative for nausea and vomiting Eyes— Negative for blurred vision Neuro—Negative for headache PFSH:Past history—surgeries and illnesses reviewed, current meds Social history—Nonsmoker, moderate alcohol Note: Only 2 of 3 PFSH are needed for complete for Emergency Department, but all three are needed for a complete PFSH for a hospital admit.